69O-191.035, F.A.C.
69O-191.035. Co-Payments
Cite as Fla. Admin. Code r. 69O-191.035
(1) If required, co-payments will be paid when health care services and benefits are rendered. The HMO or contracted provider may assess the usual co-payment when a subscriber fails to keep a physician office visit or appointment, provided this is a standard procedure and a prior reminder was issued to the subscriber of the scheduled appointment.
(2) The contract shall clearly define the co-payment required to be paid by the subscriber/member.
(3) The contract shall clearly define any cost sharing features, the financial responsibility of the subscriber/member, and how the subscriber/member obligation is determined.
(4) In the case of a high deductible contract, as defined in Section 641.20185, F.S., the deductible established under the contract must be satisfied before the application of any co-payments.